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. 2023 Jul 22;11(1):123.
doi: 10.1186/s40337-023-00838-4.

Diabetes distress and disordered eating behaviors in youth with type 1 diabetes: the mediating role of self-regulatory fatigue and the moderating role of resilience

Meijing Zhou #  1 , Hong Wang #  1 , Jian Yu #  1 , Dan Luo  2 , Min Zhu  1 , Mei Zhang  1 , Jingjing Xu  3 , Tao Yang  1
Affiliations

Diabetes distress and disordered eating behaviors in youth with type 1 diabetes: the mediating role of self-regulatory fatigue and the moderating role of resilience

Meijing Zhou et al. J Eat Disord. .

Abstract

Background: Despite previous research on the association between diabetes distress and disordered eating behaviors (DEBs) among youth with type 1 diabetes (T1D), there is a lack of understanding regarding the underlying mechanisms. This study aimed to investigate the relationships between diabetes distress and DEBs, specifically examining whether self-regulatory fatigue mediated the relationship and whether resilience moderated this mediation.

Methods: A cross-sectional study was performed among youth with T1D recruited from two diabetes centers in Nanjing, China. Measurement instruments included the problem areas in the diabetes-5 scale, the diabetes strengths and resilience measure for adolescents, the self-regulatory fatigue scale, and the Chinese version of diabetes eating problem survey-revised. Mediation and moderated mediation analyses were conducted.

Results: A total of 185 youths with T1D were involved in the current study. The results indicated that diabetes distress positively predicted DEBs. Self-regulatory fatigue partially mediated the association between diabetes distress and DEBs, accounting for 50.88% of the overall effect. Additionally, the pathway from self-regulatory fatigue to DEBs was moderated by resilience.

Conclusion: The current study examined whether self-regulatory fatigue mediated the relationship between diabetes distress and DEBs and whether resilience moderated the connection between self-regulatory fatigue and DEBs. These findings add to the theoretical basis of how diabetes distress influences DEBs and help guide the incorporation of diabetes distress, self-regulatory fatigue, and resilience into DEBs reduction programs for youth with T1D.

Keywords: Diabetes distress; Disordered eating behaviors; Resilience; Self-regulatory fatigue; Type 1 diabetes.

Plain language summary

A high prevalence of disordered eating behaviors (DEBs) has been observed among youth with type 1 diabetes (T1D), leading to poor glycemic control, significant short- and long-term consequences, and an increased mortality risk. It is crucial to closely monitor DEBs in this population and identify factors that can be modified to develop targeted interventions. While previous studies have shown that diabetes distress, which refers to negative emotions specific to diabetes, is a positive predictor of DEBs, no research has examined how diabetes distress affects DEBs. Our cross-sectional study discovered a significant association between diabetes distress, self-regulatory fatigue, and an increased likelihood of experiencing DEBs. Furthermore, low resilience exacerbates this relationship, whereas high resilience weakens it. These findings highlight the importance of integrating resilience, self-regulatory fatigue, and diabetes distress in DEBs reduction programs among youth with T1D.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The mediation model of diabetes distress, self-regulatory fatigue, and disordered eating behaviors. α The effect of diabetes distress on self-regulatory fatigue; b The effect of self-regulatory fatigue on disordered eating behaviors; c The total effect of diabetes distress on disordered eating behaviors; c’ The direct effect of diabetes distress on disordered eating behaviors; ***p < 0.001. Unstandardized beta coefficients were reported.
Fig. 2
Fig. 2
The moderated mediation model of diabetes distress, self-regulatory fatigue, resilience, and disordered eating behaviors. α The effect of diabetes distress on self-regulatory fatigue; b The effect of self-regulatory fatigue on disordered eating behaviors; c The direct effect of diabetes distress on disordered eating behaviors; d The effect of resilience on disordered eating behaviors; e The effect of the interaction term of resilience and self-regulatory fatigue on disordered eating behaviors ***p < 0.001; **p < 0.01. Unstandardized beta coefficients were reported
Fig. 3
Fig. 3
Moderating effect of resilience on the pathway from self-regulatory fatigue to disordered eating behaviors
See this image and copyright information in PMC

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